1366496937 NPI number — TRIDENT MEDICAL CENTER LLC

Table of content: (NPI 1366496937)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366496937 NPI number — TRIDENT MEDICAL CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRIDENT MEDICAL CENTER LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366496937
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9330 MEDICAL PLAZA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLESTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29406-9104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-847-7000
Provider Business Mailing Address Fax Number:
843-847-4086

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9330 MEDICAL PLAZA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29406-9104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-847-7000
Provider Business Practice Location Address Fax Number:
843-847-4086
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
ANDY
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
843-847-4100

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1004107 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 166376800 . This is a "DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 733728 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 909075400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00096542 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00881944X , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01601129 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1000037000 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1537918 . This is a "UNITED MINE WORKERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 269338 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3025186 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 032516900 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100506046 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5000221 . This is a "PHYSICIANS HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 81237100 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: XHSP33273 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10043717 . This is a "GATEWAY MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200357120A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 272545 . This is a "BLACK LUNG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30696 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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